Begin Health Care Before the Beginning

It doesn't take a brain surgeon...or a cardiologist...or a pediatrician...or even a policy wonk to figure out that a penny's worth of preventive care is worth many dollars of sick care. That the best Rx for American health -- one that can stem the codependent epidemics of obesity, diabetes, high blood pressure, heart disease, and cancer; screen for disease in its earliest and most treatable stages; and catch little problems (a 5-year who's cultivating a belly, a passion for all things fried and sugar-coated, and an allegiance to the sofa) before they become big problems (a 50-year old who's fat, unfit, and moving quickly up the ladder of completely avoidable conditions, accumulating a team of specialists and a drawer-full of pricey medications as he goes) -- is also the best Rx for out-of-control health care costs. In a word we all get: prevention.

But where to start? Clearly, the earlier in life that prevention prescription is written -- and filled -- the better. While it's never too late (to defy diabetes or bypass coronary artery disease by coaxing a confirmed coach potato onto the treadmill or a drive-through devotee into the produce aisle), it's also never too soon.

As obesity creeps into preschools, and hypertension and type II diabetes become pediatric problems for the very first time, the case for starting preventive health care in the cradle has become too compelling to keep ignoring. So while we're finally having this essential conversation about health care reform and the pivotal role prevention should play in it, let's talk about starting sooner. Let's encourage breastfeeding. Well baby visits. Complete and on-time vaccinations. Let's nurture healthy habits in kids right from the start - so eating well, exercising, and maintaining a normal weight will be second nature, not a struggle, by the time they're adults.

Or actually, while we're at it, let's start even sooner. Let's leave no child behind when it comes to health care, but let's also remember that health begins before birth -- and that health care should, too. Sadly, shamefully, and to many, surprisingly, the US -- according to the most recent numbers from the March of Dimes -- ranks 30th in infant mortality, wedged uncomfortably between Poland and Slovakia. We, the wealthiest nation in the world, spend more on health care than any other country, yet by any reasonable measure, we don't have the healthiest babies -- not even close (and not even when you factor in our higher rate of higher-risk births and the extraordinary efforts of our NICUs to save the tiniest and sickest infants).

The healthy baby gap is even more glaring in certain states (not surprisingly, those with low levels of health care access and health insurance coverage, and high levels of poverty and teen pregnancy) and among at-risk populations (especially African-Americans). Some stunning examples of those healthy baby disparities: The infant mortality rate for black babies is about two and a half times greater than it is for white babies; an African-American woman is twice as likely to give birth prematurely as a white woman; a black infant is nearly four times more likely to die as a result of being too early and/or too small than a white infant.

What's the prescription for healthier babies? For one important thing, starting health care at the beginning -- and starting every pregnancy with prenatal care. Providing comprehensive, affordable well-pregnancy care -- prenatal checkups that begin soon after conception, and screen for and catch those small, easily controlled pregnancy problems before they become big, complicated, expensive ones - to every expectant mom (as of 2004, only 75% of expectant moms received adequate prenatal care; for black and Hispanic moms-to-be that fully-cared for number is at least 30% lower). Providing maternity coverage to every potential-mom, even if she doesn't currently have baby-making on her to-do list (over 20% of all women of childbearing age do not have health insurance - a recipe for prenatal and/or financial disaster if they do end up conceiving). And possibly just as important, serving up that vital care and coverage along with a healthy, empowering side of pregnancy information and support (being pregnant - and those who've been, know - isn't ever easy).

And talk about cost effective. The price of prenatal care, information, and support is chump change compared to the potential cost of not offering it (in a too-common scenario: a preterm birth that could have been prevented with earlier, routine care delivers a tiny, critically ill premie requiring months of NICU care, followed by a lifetime of care for any disabilities or chronic health problems caused by that too-early birth). The average cost of a healthy, term baby's medical care from birth to first birthday? Just a shade under $5,000. The average medical costs for a baby born prematurely and/or at a low birthweight? Over ten times that. (And yes, the cost of a healthy baby: priceless).

Want to close the healthy baby gap -- and lower costs -- even further (and who doesn't)? Let's start even sooner. Let's begin health care before the beginning. Let's rewind not just to early childhood, or birth, or even to pregnancy. Let's write that Rx for prevention before a baby is conceived. Before sperm meets egg. Before mom and dad even get busy. Months before. Even years.

The science of preconception -- and how a couple's health at the time of conception can affect not only the health of a pregnancy and the health of a baby, but the health of a baby much later in life -- is still in its infancy. But what we've learned even in the five years since the CDC first got the preconception party started -- by launching the first preconception initiative ever in 2005 -- is pretty persuasive stuff. Apparently, much of a person's future health profile -- from risk of obesity to risk of chronic disease to risk of cancer to life expectancy -- is penciled in, if not carved in stone, before that person is even conceived. Why is why preconception planning should be an integral piece of that healthy baby prescription.

Preconception-prevention case in point: Obesity, which has been shown to greatly increase the risks for a pregnant woman, her pregnancy, her baby's health at birth, and her baby's future health. An obese woman who loses weight before she conceives not only dramatically reduces her chances of developing gestational diabetes (an often preventable condition that can put pregnancy at high risk for complications and sends costs for care soaring), but the chances that her baby will be born too big (requiring a surgical delivery) and/or with birth defects; become obese as a child; and develop Type II diabetes as an adult.

Another perk of preconception planning -- and to making preconception counseling a routine, completely covered component of ob/gyn care: A woman who gets enough folic acid in the three months preceding pregnancy lowers the risk of neural and other birth defects; one who takes prenatal vitamins in the year before she and her partner conceive lowers her risk of delivering prematurely. You don't have to haul out the calculator again to realize that these and other relatively inexpensive, easy-to-implement preconception steps offer a compelling cost-benefit ratio -- one that you can take to the health care savings bank, for a healthier bottom line and a healthier baby -- top to adorable bottom.